
<script language="javascript">
function ctrl_champs() {
  if (document.forec.nomfx.value   == '' ||
      (document.forec.adr1f.value  == '' &&
       document.forec.adr2f.value == '' &&
       docucent.forec.adr3f.value == '') ||
       document.forec.localf.value == '' ||
       document.forec.paysf.value == '' ||
       document.forec.passw1.value == '' ||
      (document.forec.telf.value  == '' &&
       document.forec.natelf.value  == ''))
     {
     alert('<!--WSTAG name="err_adr" -->');
     return false;
  }

  return true;
}
</script>

<!--WSTAG name="prog_suivant" -->

<!--WSTAG name="texte1" -->

<form method="post" action="" name="forec" Onsubmit="//return ctrl_champs();">
  <!--WSTAG name="texte2" -->

  <br />
<br />
<div style="text-align:center">
    <font size="1" face="Verdana, Arial, Helvetica, sans-serif">
    
  <table border="0" cellpadding="0" cellspacing="2">
    <tr valign="middle"> 
      <td width="200" align="right"><font size="2" face="Arial, Helvetica, sans-serif"><sup><font color="#FF0000">* 
        </font></sup> 
        <!--WSTAG name="lab_civil" -->
        : </font></td>
      <td width="400" align="left"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <input name="civilf" type="text" id="nomf4" size="30" maxlength="50">
        </font></td>
    </tr>
    <tr valign="middle"> 
      <td width="200" align="right"> <font size="2" face="Arial, Helvetica, sans-serif"><sup><font color="#FF0000">* 
        </font></sup> 
        <!--WSTAG name="lab_nom" -->
        : </font></td>
      <td width="400" align="left"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <input name="nomfx" type="text" id="nomf3" size="30" maxlength="50">
        </font></td>
    </tr>
    <tr valign="middle"> 
      <td width="200" align="right"> <font size="2" face="Arial, Helvetica, sans-serif"><sup><font color="#FF0000">* 
        </font></sup> 
        <!--WSTAG name="lab_adresse" -->
        : </font></td>
      <td width="400" align="left"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <input name="adr1f" type="text" id="adr1f" size="30" maxlength="50">
        </font></td>
    </tr>
    <tr valign="middle"> 
      <td><font size="2" face="Arial, Helvetica, sans-serif">&nbsp;</font></td>
      <td width="400" align="left"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <input name="adr2f" type="text" id="adr2f" size="30" maxlength="50">
        </font></td>
    </tr>
    <tr valign="middle"> 
      <td><font size="2" face="Arial, Helvetica, sans-serif">&nbsp;</font></td>
      <td width="400" align="left"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <input name="adr3f" type="text" id="adr3f" size="30" maxlength="50">
        </font></td>
    </tr>
    <tr valign="middle"> 
      <td width="200" align="right"> <font size="2" face="Arial, Helvetica, sans-serif"><sup><font color="#FF0000">* 
        </font></sup> 
        <!--WSTAG name="lab_local" -->
        : </font></td>
      <td width="400" align="left"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <input name="nopostf" type="text" id="nopostf" size="6" maxlength="10">
        <input name="localf" type="text" id="localf" size="30" maxlength="50">
        </font></td>
    </tr>
    <tr valign="middle"> 
      <td width="200" align="right"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <sup><font color="#FF0000">*</font></sup> 
        <!--WSTAG name="lab_pays" -->
        : </font></td>
      <td width="400" align="left"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <select size="1" name="paysf">
        </select>
        </font></td>
    </tr>
    <tr valign="middle"> 
      <td width="200" align="right"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <!--WSTAG name="lab_mail" -->
        : </font></td>
      <td width="400" align="left"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <input name="mailf" type="text" id="mailf" size="30" maxlength="80">
        </font></td>
    </tr>
    <tr valign="middle"> 
      <td width="200" align="right"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <!--WSTAG name="lab_tel" -->
        : </font></td>
      <td width="400" align="left"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <input name="telf" type="text" id="telf" size="30" maxlength="80">
        </font></td>
    </tr>
    <tr valign="middle"> 
      <td width="200" align="right"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <!--WSTAG name="lab_natel" -->
        : </font></td>
      <td width="400" align="left"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <input name="natelf" type="text" id="natelf" size="30" maxlength="80">
        </font></td>
    </tr>
    <tr valign="middle"> 
      <td height="50" colspan=2"> <font size="2" face="Arial, Helvetica, sans-serif"> 
        <!--WSTAG name="lab_news" -->
        &nbsp;&nbsp;&nbsp;&nbsp; 
        <input type="checkbox" name="news" value="ON">
        </font></td>
    </tr>
    <tr valign="middle"> 
      <td height="30" colspan=2"><font size="2" face="Arial, Helvetica, sans-serif"> 
        <font size="2" face="Arial, Helvetica, sans-serif"><sup><font color="#FF0000">* 
        </font></sup> 
        <!--WSTAG name="lab_mobli" -->
        </font></font></td>
    </tr>
  </table>

  <!--WSTAG name="navigation" -->

  <input type="hidden" name="FRowid"  value="?">
  <input type="hidden" name="LRowid"  value="?">
  <input type="hidden" name="lang" value="10">
  <input type="hidden" name="par-prog" value="?">
</font></form><font size="1" face="Verdana, Arial, Helvetica, sans-serif">

<!--WSTAG name="erreur" -->


<!--WSTAG name="texte3" -->



